Exam 1 Flashcards
(114 cards)
1
Q
What are the CNs that innervate the various muscles of the eye?
A
3, 4, 6 (SO4 LR6 R3)
2
Q
Which CN causes mydriasis (dilation) and miosis (constriction)?
A
3
3
Q
How will the eye respond if CN3 is damaged?
A
It will go down and out
4
Q
If a patient has a left afferent papillary defect and you shine a light into the right eye, how will the eyes respond? how about the left eye?
A
Right eye: both eyes will constrict
Left eye: neither eye will react
5
Q
What causes an efferent papillary defect to occur?
A
Trauma causing the impulse from brain to eye via CN3 to be damaged
6
Q
If the patient’s left eye is affected in an efferent papillary defect, how will it react when hit with light? how about if the right (good eye) is hit with light?
A
Both will cause the good eye to constrict and the bad eye to no react
7
Q
Which parts of the eye measure sharpness and is where the light focuses?
A
Macula and fovea
8
Q
Pt has hypertension and you notice decreased sharpness w/in the eye around the borders upon ophthalmoscopic exam…what do you expect her to have?
A
Papilledema
9
Q
If a patient wakes up and they cannot see at all, what pathology can you expect from an ophthalmoscopic standpoint?
A
Hyphema - blood in the anterior chamber of the eye that has pooled b/c the patient was laying down
10
Q
What is the syndrome called when you lose sympathetics to the eye?
A
Horner’s syndrome
11
Q
What innervates Mueller’s muscle?
A
Sympathetics
12
Q
What are the triad of symptoms involved with loss of innervation to Mueller’s muscle?
A
Ptosis of eye, Anhydrosis, Miosis
13
Q
If a patient is experiencing bitemporal hemianopsia (tunnel vision) what happened?
A
Their optic chiasm was cut
14
Q
If a patient is experiencing homonymous hemianopsia (cut left, right is blocked out and vice versa), what happened?
A
Their optic tract was cut
15
Q
If a patient is experiencing ipsilateral eye blindness?
A
Their optic nerve was cut (cut left, lose left and vice versa)
16
Q
What is it called when a patient has increased intraocular pressure?
A
Glaucoma
17
Q
What is it called when the lens of the eye is clouded?
A
Cataract
18
Q
What is it called when an eye can accommodate, but not respond with direct light?
A
Argyll Robertson Pupil - like a hooker - often seen in syphillis
19
Q
What is it called when a patient’s pupils are not equal in size?
A
Anisocoria
20
Q
What type of pupils are found in a comatosed or brain dead patient?
A
Dilated fixed pupils
21
Q
What type of pupils are common in patients with narcotic issues?
A
constricted fixed pupils
22
Q
If a patient has conductive hearing loss, what will the result of a Rinne test be?
A
BC > AC
23
Q
If a patient has senseroneurial hearing loss, what will the result of a Rinne test be?
A
AC > BC
24
Q
What does the Weber test test?
A
Lateralization
25
What type of hearing loss is present if the Weber test lateralizes to the bad ear?
Conductive hearing loss
26
What type of hearing loss is present if the Weber test lateralizes to the good ear?
Senseroneurial hearing loss
27
Why would a patient sneeze when placing an otoscope into their ear?
It can stimulate the vegas nerve
28
When examining a nasal cavity what does a unilaterally enlarged turbinate indicate?
A chronic septal deviation - otherwise, it is acute
29
If a patient experiences a subcondylar fracture, which direction will the jaw deviate toward?
The affected side
30
What is the order of evaluation for the thorax or heart?
Inspection, palpation, percussion, auscultation
31
Which organs are you concerned about in a patient with funnel chest? Why are you concerned about them?
Heart and lungs - they are being compressed due to the compression in the center of the anterior thorax
32
When the thorax is deviated, what is the condition called?
Kyphosis
33
Does it take longer to expire or inspire air?
Expire (about 2x longer)
34
When a patient is experiencing hyperpnea or hyperventilation, how would you treat the patient?
Put them into a rebreather (i.e. a paper bag) so they can restore their CO2 levels
35
When can Cushing's triad been seen in a patient?
When a patient has intracranial pressure
36
What are the three things involved with Cushing's triad?
Hypertension, Bradypnea, Bradycardia
37
When you notice a patient undergoing a period of faster and deeper breathing followed by a period of apnea (no breathing), what is it called?
Cheyne-Stokes breathing
38
What is the most common cause of right side heart failure?
Left side heart failure
39
What are the two things that keep fluid within a blood vessel?
Oncotic pressure (pressure that allows fluid to enter a capillary) and Hydrostatic pressure (pressure that pushes fluid out of a capillary)
40
What does it mean when oncotic pressure > hydrostatic pressure?
fluid enters a capillary
41
When you notice a patient experiencing egophony, bronchophony, and/or whispered pectoriloquy, what disease would they have?
Pneumonia - and more specifically, pulmonary consolidation
42
What is egophony?
When 'ay' changes to 'ee' when using a stethoscope
43
What is bronchophony?
Through a stethoscope: when a patient speaks, and it sounds like an echo
44
What is Whispered pectoriloquy?
When a patient whispers, it sounds loud
45
if you hit on a patient's chest that has bronchitis, what kind of sound will you hear?
A dull sound
46
What does it sounds like when you hit on a patient's chest that has emphysema? why?
it would sound like a drum; b/c in emphysema, air gets trapped, causing the interalveoli septi to be destroyed and the sound to be hyperresonant
47
What is a tension pneumothorax?
A collapsed lung that occurs due to a puncture - a pressure buildup would occur, causing things within the lungs to be pushed around - causes a decrease of blood flow to the heart
48
Which direction would the trachea deviate if a patient has a pneumothorax?
away from the affected lung
49
How do the heart valves react in systole?
Aortic & Pulmonic: open
| Mitral & Tricuspid: closed
50
How do the heart valves react in diastole?
Aortic and Pulmonic: closed
| Mitral & Tricuspid: open
51
Systolic or diastolic: Mitral valve prolapse (regurgitation)
Systolic
52
Systolic or diastolic: Aortic valve regurgitation
Diastolic
53
Systolic or diastolic: Pulmonic valve stenosis
Systolic
54
Systolic or diastolic: Tricuspid valve stenosis
Diastolic
55
When could you expect to hear a mid-systolic click?
During mitral/tricuspid valve regurgitation upon opening of the valve
56
During pulsus alterans, which type of pulse can you expect to see?
a weak pulse followed by a strong pulse
57
What is pulsus paradoxis?
During inspiration, BP decreases due to decreased interthroacic pressure and therefore, decreased venous return to the heart
58
When is pulsus paradoxis seen in a patient?
during cardiac tamponade and COPD
59
Where is the point of max impulse typically located?
5th intercostal space, just left of the sternum
60
During CHF, the heart enlarges, what then happens to the point of max impulse?
it moves inferior and to the left
61
if you are going to only check one area when checking the heart, where would you check?
Erb's space - heart murmurs are referred here
62
Where is Erb's space?
left 3rd IC space
63
What is S1?
"Lub" - the sound from the mitral and tricuspid valves closing
64
What is S2?
"Dub" - the sound from the aortic and pulmonic valves closing
65
What is an example of a heart defect where fixed splitting of S2 is evident?
Atrial septal defect (ASD)
66
What is a murmur?
The sound of turbulent blood flow
67
Which type of murmur exhibits a crescendo-decrescendo shape of intensity?
a systolic (book says mid-systolic) murmur
68
What can cause a pansystolic (holosystolic) murmur?
Mitral/tricuspid regurgitation or Ventricular septal defect
69
What is clotication a sign of?
Peripheral Vascular Disease - which is then indicative of CVD
70
Which sounds are present during systole and diastole?
Pericardial friction rub, Patent ductus arteriosus, Venoous hum
71
What is an organic murmur?
a pathologic condition
72
what is a functional murmur?
there is an alteration in anatomy, but the alteration is not pathological
73
What is an innocent murmur?
no alteration in anatomy, and no pathology are present - this murmur is a sound due to high cardiac output through normal anatomy
74
What is the order of evaluation within the abdomen?
1) Inspection
2) Auscultation
3) Palpation
4) Percussion
75
What is the term for high pitched bowel sounds that are often indicative of impending bowel obstruction?
Bor Borygmus - rebound tenderness - press down and when it hurts when you let go, that indicates peritonitis
76
What is Murphy's sign? and what does a positive test indicate?
palpation of the RUQ causes inspiratory arrest - causes Acute cholecystitis
77
What is Kehr's sign? and what does the sign indicate?
pain in the left shoulder - indicates a splenic fracture
78
Which organs are included in the retroperitoneum?
- Pancreas
- Duodenum
- Kidney
- Ureter
79
What is Gray-Turner sign? and what does it indicate?
bruising in the flanks - indicates a retroperitoneal bleed
80
What is Cullen's sign? and what does it indicate?
superficial bruising of umbilicus - indicates pancreatitis
| - patient may experience pain burrowing from back to front
81
What is Rousing sign? and what does it indicate?
pain occurs in LRQ from pushing on LLQ - indicates appendicitis
82
What is Psoas sign? and what does it indicate?
patient lays flat, you raise their leg (or if the patient is standing, then you swing the patient's leg behind them) - if abdomen pain forms, it is indicative of appendicitis
83
what resembles left side appendicitis?
Diverticulitis - patient feels pain in LLQ
84
What is it called when the ab muscles separate into two distinct ridges upon contraction?
Diastasis Recti
85
When a patient has shifting dullness, what is that indicative of? What are the diseases associated with this?
Indicative of Ascites - Liver disease, congestive heart failure
86
What are the five separate components required by a deep tendon reflex (DTR)
1) Intact sensory organs
2) functional synapse in the spinal cord
3) intact motor nerve fiber - efferent
4) functional neuromuscular junction (NMJ)
5) competent muscle fiber
87
What is the Babinski sign? what does it indicate?
upon dragging pressure to bottom of an adult patient's foot, the great toe dorsal flexes, while the other toes fan out (big toe goes up, others go down) - indicates Upper motor neuron damage
88
When testing a unilaterally damaged CNX, you press a tongue depressor and you notice the uvula deviates. which direction does it go?
It deviates toward the normal side (away from the affected side)
89
When testing CNXII, you ask the patient to stick their tongue out. When they do, it deviates to the right. What does this indicate?
This indicates a right side CNXII problem
90
What does the Glasgow Coma Scale measure?
Best Eye opening
Best Motor response
Best Verbal response (graded from 3-15)
91
What is the Brudzinski test? what does this indicate?
If the patient is laying flat, you raise their head and the patient will bend their knee by reflex - indicates meningeal irritation
92
What is the Kernig test? what does this indicate?
If the patient is laying flat, you bend their knee, and their head will raise as a reflex - indicates meningeal irritation
93
What is the occulocephalic reflex test? what does it test for?
(AKA doll's eye test) turn patient's head to left and right and the eyes should stay forward...like a doll - if their eyes do not react like this, then their brainstem is not functioning properly
94
What is the occulovestibular reflex? What does it test for?
Inject ice water at 30 degree angle into ear - patient's eyes should move toward irrigated ear, then scan back - if this result occurs, then the patient's brainstem is functioning properly
95
What is the Chovstek test?
Tap the patient's zygoma with your finger, if they are hypocalcemic, they will spasm on that side of the face
96
What is Trousseau's test?
Pump the BP cuff to ~30mmHg - if the patient goes into a carpopedal spasm, then they are hypocalcemic
97
Which nerve is affected in Carpal Tunnel Syndrome?
Median n.
98
What is Tinel's sign?
Hit the base of the palm or funny bone and if the patient feels tingling, they have carpal tunnel
99
What is Phalen's sign?
Press wrists together, then, after a while, if the patient feels numbness, it is indicative of injury to the median n. in the carpal tunnel
100
What is decorticate rigidity? Why does it happen?
Toes plantar flex, arms flex and adduct, wrists flex - the cortical region of the brain has been cut
101
What is decerebrate rigidity? Why does it happen?
Toes plantar flex, arms extend and pronate, wrists flex - the brain has been completely cut from the rest of the body
102
What is Bell's Palsy and how does it occur?
the patient loses all impulses to 1/2 of the face. it happens due to a Lower motor nerve injury
103
What is one of the first sensations lost by a diabetic patient?
Vibration - this should be one of the first things a physician tests for in a diabetic
104
What does a unilateral dilated pupil in a patient indicate is occuring?
The patient has a hematoma that is pressing on the occulomotor n. The pressure is on the same side as the eye dilation
105
What is the corneal flex test?
use a cotton wisp on the cornea and look for blinking of the eye - it is testing for CN5 & 7
106
what is the jaw jerk reflex test and what does it test?
put finger on the genoid and hit it with a rubber hammer - it tests CN5
107
When is a mid-systolic click seen?
Mitral/tricuspid regurgitation
108
When is a systolic ejection murmur (mid-systolic ejection murmur) seen?
Aortic &pulmonary stenosis
109
When would you notice a crescendo/decrescendo murmur?
During systole-specifically aortic stenosis
110
Which murmur is consistent with psychiatric problems?
Mitral valve prolapse (regurgitation)
111
How does the trachea react during Atelectasis?
Trachea moves toward affected side
112
How does the trachea react in a pneumothorax?
Trachea deviates away from the affected side
113
How does the uvula react when CNX is damaged unilaterally?
Uvula deviates away from affected side
114
With a subcondylar fracture, which way does the jaw deviate?
Jaw deviation toward the affected side
